# Leveraging Computerized Adaptive Testing for Cost-effective Evaluation of Large Language Models in Medical Benchmarking

arXiv: https://arxiv.org/abs/2603.23506 · HTML: https://mlsanity.com/paper/2603.23506/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 14 of its 43 references that are in the map.
- First posted on arXiv 28 Feb 2026.

## Builds on (most cited first, 14 of 14)

- [Measuring Massive Multitask Language Understanding](https://mlsanity.com/paper/2009.03300/) (2020)
- [Beyond the Imitation Game: Quantifying and extrapolating the capabilities of language models](https://mlsanity.com/paper/2206.04615/) (2022)
- [Large Language Models Encode Clinical Knowledge](https://mlsanity.com/paper/2212.13138/) (2022)
- [What Disease does this Patient Have? A Large-scale Open Domain Question Answering Dataset from Medical Exams](https://mlsanity.com/paper/2009.13081/) (2020)
- [MedMCQA : A Large-scale Multi-Subject Multi-Choice Dataset for Medical domain Question Answering](https://mlsanity.com/paper/2203.14371/) (2022)
- [tinyBenchmarks: evaluating LLMs with fewer examples](https://mlsanity.com/paper/2402.14992/) (2024)
- [Med-HALT: Medical Domain Hallucination Test for Large Language Models](https://mlsanity.com/paper/2307.15343/) (2023)
- [Large Language Model Psychometrics: A Systematic Review of Evaluation, Validation, and Enhancement](https://mlsanity.com/paper/2505.08245/) (2025)
- [Position: AI Evaluation Should Learn from How We Test Humans](https://mlsanity.com/paper/2306.10512/) (2023)
- [LLMEval-Med: A Real-world Clinical Benchmark for Medical LLMs with Physician Validation](https://mlsanity.com/paper/2506.04078/) (2025)
- [MedBench: A Large-Scale Chinese Benchmark for Evaluating Medical Large Language Models](https://mlsanity.com/paper/2312.12806/) (2023)
- [Pattern Recognition or Medical Knowledge? The Problem with Multiple-Choice Questions in Medicine](https://mlsanity.com/paper/2406.02394/) (2024)
- [The Illusion of Readiness in Health AI](https://mlsanity.com/paper/2509.18234/) (2025)
- [Survey of Computerized Adaptive Testing: A Machine Learning Perspective](https://mlsanity.com/paper/2404.00712/) (2024)

## Abstract (arXiv)

The rapid proliferation of large language models (LLMs) in healthcare creates an urgent need for scalable and psychometrically sound evaluation methods. Conventional static benchmarks are costly to administer repeatedly, vulnerable to data contamination, and lack calibrated measurement properties for fine-grained performance tracking. We propose and validate a computerized adaptive testing (CAT) framework grounded in item response theory (IRT) for efficient assessment of standardized medical knowledge in LLMs. The study comprises a two-phase design: a Monte Carlo simulation to identify optimal CAT configurations and an empirical evaluation of 38 LLMs using a human-calibrated medical item bank. Each model completed both the full item bank and an adaptive test that dynamically selected items based on real-time ability estimates and terminated upon reaching a predefined reliability threshold (standard error <= 0.3). Results show that CAT-derived proficiency estimates achieved a near-perfect correlation with full-bank estimates (r = 0.988) while using only 1.3 percent of the items. Evaluation time was reduced from several hours to minutes per model, with substantial reductions in token usage and computational cost, while preserving inter-model performance rankings. This work establishes a psychometric framework for rapid, low-cost benchmarking of foundational medical knowledge in LLMs. The proposed adaptive methodology is intended as a standardized pre-screening and continuous monitoring tool and is not a substitute for real-world clinical validation or safety-oriented prospective studies.